Outcomes from brain death donors with cardiac arrest (caDBD)

accepted for pancreas transplantation

Pedro Ventura-Aguiar1,2, Joana Ferrer3, David Paredes4, Camino Rodriguez-Villar4, Angel Ruiz4, Josep Fuster3, Constantino Fontdevilla3, Enric Esmatjes5, Ramon Adália4, Federico
NOTHING TO DISCLOSE
Oppenheimer1,2,6, Josep M Campistol1,6, Fritz Diekmann1,2,6, Maria J Ricart1.
1. Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Spain; 2. Laboratori Experimental de Nefrologia I Trasplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain;
3. Hepatobiliopancreatic and Liver & Pancreas Transplant Departmen; 4. Donation and Transplantation Coordination Unit,; 5. Diabetes Unit, Department of Endocrinology and Nutrition,. REDinREN

Table 2 – Pancreas surgical complications

BACKGROUND AND AIMS RESULTS caDBD

(n= 49)
RESULTS
Other DBD
(n= 296)
p

Admission length
13 [10-19] 15 [11-24] .56
(days; median [IQR])
Donors after cardiocirculatory death (DCD) have been used for Pancreas transplants Graft failure <90 days (n/%) 4 (8.2%) 29 (9.8%) .79

pancreas transplantation, with good outcomes. Warm ischemia (n=345) Technical Failure 4 (8.2%) 27 (9.2%) .62
Clavien-Dindo (%)* .53
times documented in these reports vary from an average of 5.3 No complication 69.6% 58.3%
to 30minutes 7–10, and up to a maximum of 57 minutes. Grade I 2.2% 7.3%
Grade II 4.3% 5.8%

Literature reports on the effect of cardiac arrest prior to Grade IIIa 6.5% 4.2%
Grade IIIb 15.2% 22.8%
pancreas donation from donors after brain death (DBD) are Grade IVa 2.2% 1.5%
scarce. In pre-procurement P-PASS score emphasis is given caDBD Grade VIb 0% 0%
Other DBD Grade V 0% 0%
to donor cardiac arrest, with a cufoff value of 5min determined (n=49) (n=296) Re-laparotomy (n/%) 14 (29%) 83 (28%) .88
by expert opinion. Days to re-laparotomy
8 [2-19] 14 [4-44] .62
Figure 2 - ROC curve analysis performed
• median Cardiac arrest time (CAT): 5.0 min [IQR 2.5-15.0]; (median [IQR]) to discriminate cardiac arrest time (CAT)
We aimed at evaluating the effect of a cardiac arrest in DBD minimum 1min, maximum 45min), Graft Thrombosis
(partial or total; %)
22.4% 20.8% .85
and the incidence of technical failure (TF).

donors on pancreas graft outcomes. • age of 29.0 years (SD 10.2)

Thrombosis treatment (%)
• BMI of 23.6 Kg/m2 (SD 3.4).
• COD: Anoxic encephalopathy most frequent (32.7% vs Conservative 36.4% 50.0% .80
1.8% in other DBD; p=0.000). Interventional radiology 27.2% 26.8%
METHODS • P-PASS score higher (16.9 vs 15.6 in other DBD; p=0.005).
• P-PASS sub-categories - only cardiac arrest scores
Surgical 36.4% 23.2%

*Clavien-Dindo was calculated to pancreas complications only;

significantly higher (2.5 vs 1.0 in other DBD; p=0.000).
We conducted a single center retrospective analysis • PDRI similar between both groups
• All remaining demographic and clinical characteristics were
including all DBD donors accepted for pancreas similar between both groups (p>0.05). Figure 3 – Kaplan-Meier
transplantation (PTx) from January 1st, 2000 until December pancreas graft survival
31st, 2016, including simultaneous pancreas-kidney (SPK), estimates in caDBD with
pancreas after kidney (PAK), and pancreas transplant alone a CAT over 15minutes
(caDBD>15) is
(PTA) recipients.
significant inferior (log-
Definitions: rank p=0.001) compared
to caDBD with CAT <
a) Patient survival: last day of follow-up, date of death with a 15min (caDBD<15) and
functioning pancreas graft, or at 90 days following failure of other DBD.
pancreas graft (or both grafts in SPK).
b) Pancreas graft failure: graft removal, C-peptide <1ng/mL,
total daily insulin need >0,5U/Kg, or patient death;
c) Kidney graft failure: return to dialysis, re-transplantation, or
patient death. CONCLUSIONS
d) Technical failure (TF) was defined as any non- •caDBDs are suitable for routine use in pancreas transplantation;
immunological graft failure during the first 90 days following •Technical failure incidence was similar between caDBD and other DBD
pancreas transplantation. donors.

e) Anticoagulation: enoxaparin 20mg bid starting 8h post- Figure 1 – Kaplan-Meier pancreas graft survival estimates •Cardiac arrest time over 15 minutes was associated with an increased
for DBDs with previous cardiac arrest (caDBD) and all risk for technical failure (HR 5.80 [95% CI 1.82-18.56]; p=0.003), with a
surgery and maintained until patient discharge and aspirin sensitivity of 100% and specificity of 75% for this outcome.
other DBDs accepted for pancreas transplantation.
50mg/day until discharge, then increased up to 100mg/day
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